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Kinds of Health Organisation Selected AbstractsRisk factors for suicide attempts in patients with alcohol dependence or abuse and a history of depressive symptoms: A subgroup analysis from the WHO/ISBRA studyDRUG AND ALCOHOL REVIEW, Issue 1 2010ÖZGÜR YALDIZLI Abstract Introduction and Aims. Alcoholism, depression and suicide attempts (SA) are strongly interrelated. The aims were to determine risk factors and develop a prognostic predictor model for SA in a subgroup of patients with a history of alcohol dependence or abuse and depressive symptoms. Design and Methods. A subgroup analysis from the data of the World Health Organisation (WHO)/the International Society for Biomedical Research on Alcoholism (ISBRA)-collaborative study on biological state and trait marker of alcohol use and dependence, an international multi-centre study with a cross-sectional design, based on a standardised questionnaire. We analysed from 1314 variables 43 factors,including demographic characteristics, dependence variables, comorbid disorders, personality trait markers and family history,that were supposed to be most predictive for SA according to the literature. Correlation analyses by the ,2 -test and Mann,Whitney U -test were performed to obtain statistical meaningful parameters for logistic regression analysis. Results. Of the 1863 persons included in the WHO/ISBRA study, 292 had both a history of depressive symptoms and alcohol dependence or abuse and were included in the subgroup analysis. In the logistic regression analysis, drinking status, depressive symptoms, adverse drinking experiences during alcohol consumption, bad experiences from drug abuse and antidepressant therapy were found to be independent risk factors for SA. Positive family history of alcoholism was a model-improving co-factor. This predictive model explains approximately 60% of the variance (Nagelkerkes' square). Discussion and Conclusions. This prognostic model derived from data of the WHO/ISBRA collaborative study shows important risk factors for SA in patients with history of alcohol abuse or dependence and depressive symptoms. [ Yaldizli Ö, Kuhl HC, Graf M, Wiesbeck GA, Wurst FM. Risk factors for suicide attempts in patients with alcohol dependence or abuse and a history of depressive symptoms: A subgroup analysis from the WHO/ISBRA study. Drug Alcohol Rev 2009] [source] Optimizing in-kind drug donations for Tanzania,a case studyINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 4 2008Gaby Gehler Mariacher Abstract A questionnaire survey (QS) among stakeholders in Tanzania had shown that in-kind drug donations (DDs) are important to boost the drug supply system. Major problems were their insufficient quantity for sustainable treatment and the discrepancy between the needs of the recipients and the donors' supply. Objectives in this study were to discuss these findings and to learn from key informants (KIs) how to improve the DD process. Data were collected through KI interviews in 2001/2002. A 30% gap in drug supply has to be bridged by DDs. KIs confirmed the importance of the World Health Organisation and Tanzanian DD guidelines as a tool for good donation practice and emphasized the role of the government in their implementation. They requested that donors meet the recipient country's regulatory requirements. In contrast to QS respondents, KIs did not view DD quality as a minor problem, and proposed that DD quality should be adapted to the national quality assurance procedures. DD processes could be improved through (a) effective implementation of DD guidelines as an aid for decision-making and for quality assurance, (b) availability of data to improve communication between donors and recipients, (c) transparency between recipients and donors and (d) clearly defined accountability. Copyright © 2007 John Wiley & Sons, Ltd. [source] Usefulness of smears in intra-operative diagnosis of newly described entities of CNSNEUROPATHOLOGY, Issue 6 2009Winny Varikatt The recent edition of World Health Organisation (WHO) Classification of Tumours of the Central Nervous System has incorporated a substantial number of important changes. It has recognised several new entities, many of which are rare. Intra-operative diagnosis of these tumours can be difficult with the freezing artefact that often cripples brain frozen sections. In many instances intra-operative smears are extremely useful adjuvants in neuropathological diagnosis. In this article, we describe intra-operative smear findings of three of the newly described tumours. Their characteristic cytologic features are illustrated along with differentiating features from the common mimics, together with a general approach to brain smears. The entities we discuss here are papillary glioneuronal tumour, papillary tumour of the pineal region and angiocentric glioma. All three tumours share at least focal pseudo-papillary/vasculocentric architecture. Smears from papillary glioneuronal tumour demonstrated dual population of cells in a neuropil background, whereas papillary tumour of the pineal region and angiocentric glioma comprise a single population of cells. These two tumours can further be differentiated based on their cell morphology and background. [source] Oral fungal and bacterial infections in HIV-infected individuals: an overview in AfricaORAL DISEASES, Issue 2002TA Hodgson Oral opportunistic infections developing secondary to human immunodeficiency virus (HIV) infection have been reported from the early days of the epidemic and have been classified by both the EC-Clearinghouse and the World Health Organisation (WHO). Among the fungal infections, oral candidiasis, presenting in African HIV-infected patients has been sporadically documented. We review the literature with respect to candidal carriage, oral candidiasis prevalence and the predictive value of oral candidiasis for a diagnosis of underlying HIV disease in African HIV-infected patients. The use of oral candidiasis as a marker of disease progression, the species of yeasts isolated from the oral cavity in Africa and the resistance of the yeasts to antifungal agents and treatment regimens are discussed. Orofacial lesions as manifestations of the systemic mycoses are rarely seen in isolation and few cases are reported in the literature from Africa. In spite of the high incidence of noma, tuberculosis, chronic osteomyelitis and syphilis in Africa, surprisingly there have been very few reported cases of the oral manifestations of these diseases in HIV-positive individuals. Orofacial disease in HIV-infected patients is associated with marked morbidity, which is compounded by malnutrition. The authors indicate specific research areas, initially directed at the most effective management strategies, which would complete data in this important area. [source] Epidemiology underpinning research in the aetiology of orofacial clefts,ORTHODONTICS & CRANIOFACIAL RESEARCH, Issue 3 2007Peter Mossey Structured Abstract Author,,, Mossey P Introduction,,, Epidemiological information gathered through birth defects surveillance is an important adjunct to carrying out clinical and aetiological research. Information on the incidence in the population, causative risk factors and providing baseline data prior to intervention are all important elements. Under the auspices of the World Health Organisation, it was agreed that a global registry and database on craniofacial anomalies should be created and this, the International Database on Craniofacial Anomalies (ICDFA) was designed to gather information on craniofacial abnormalities from existing birth defects registries and databases around the world to become a resource underpinning research. There are currently 62 registries covering 2 million births per year contributing to a database along with information on the size and type of studies used to collect the information, any variation in ascertainment and on the inclusion of syndromes and associated abnormalities. Generation of hypotheses,,, From the epidemiological data collected it is possible to carry out meta-analysis and to search for trends and consistencies in the data that enable hypothesis to be generated. Issues such as geographical distribution, ethnicity, gender, associated abnormalities and clefts in stillbirths can all be examined in a meta-analytical approach. Collection of information on risk factors such as maternal illnesses, medications, lifestyle factors, nutrition and perhaps occupational exposures enables investigation into environmental contribution to causality and genetic predisposition. A range of techniques are currently being used to identify new candidate genes and ultimately it will be necessary to test genetic and environmental hypothesis in the context of human population studies. Conclusions,,, It is only by consistency of association between different populations with different gene pools and maternal exposures, lifestyles, nutrition etc that conclusive evidence regarding causality will be found. It is therefore essential, and a major objective of the WHO that international multicentre collaborative studies are setup to gather the appropriate evidence and improve knowledge and the cause of birth defects in general and orofacial clefts in particular, with the ultimate humanitarian and scientific objective of the WHO being primary prevention. Clinical utility and implications,,, This IDCFA project fulfils three basic objectives namely to enable global surveillance of CFA; to create online access to those who wish to contribute to the IDCFA, and to develop an online directory of resources on craniofacial anomalies for the support of research and improving quality of care. The next sttif for IPDTOC are to expand the number of participating registries and to actively collect data on other craniofacial birth defects. [source] Breast feeding very-low-birthweight infants at discharge: a multicentre study using WHO definitionsPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 6 2009Riccardo Davanzo Summary Human milk has several advantages in the nutrition of very-low-birthweight (VLBW) infants. However, there are limited data on breast feeding (BF) in neonatal intensive care units (NICU). The aim of this study was to identify a practical definition of BF rate in VLBW infants and to test its applicability and reproducibility in Italian NICUs. The study population included all VLBW infants discharged from 12 level 3 NICUs, over a 12-month period. Type of feeding was recorded according to the World Health Organisation (WHO) definition, with a 72-h recall period. We enrolled 594 VLBW infants. Mean birthweight was 1105 g (SD: 267), mean gestational age was 29.2 weeks (SD: 2.7) and mean length of stay in NICUs was 62.5 days (SD: 56.5). At discharge, 30.5% of VLBW infants were exclusively breast fed, 0.2% were predominantly breast fed, 23.8% were on complementary feeding and 45.5% were exclusively formula fed. A wide variability in BF rates was seen between centres. Among exclusively breast-fed VLBW infants, only 10% sucked directly and exclusively at the breast. WHO definitions can be used to assess type of feeding at discharge from NICUs. We speculate that common feeding definitions may allow both comparisons among different NICUs and ratings of quality improvement programmes. [source] Baylis,Hillman adducts with molluscicidal activity against Biomphalaria glabrataPEST MANAGEMENT SCIENCE (FORMERLY: PESTICIDE SCIENCE), Issue 3 2006Mário LAA Vasconcellos Abstract The molluscicidal activities of ten Baylis,Hillman adducts against Biomphalaria glabrata (Say) snails, the intermediate host of schistosomiasis, have been determined. Nine of these compounds showed significant molluscicidal activity against B. glabrata, falling below the threshold of 100 µg ml,1 set for potential molluscicidal activity by the World Health Organisation. Among these compounds, 3-hydroxy-2-methylene-3-(4-nitrophenyl)propanenitrile had the highest activity, with LC50 = 6.64 µg ml,1. Copyright © 2006 Society of Chemical Industry [source] Influence of Sample Preparation, Staining Procedure and Analysis Conditions on Bull Sperm Head Morphometry using the Morphology Analyser Integrated Visual Optical SystemREPRODUCTION IN DOMESTIC ANIMALS, Issue 5 2001A Boersma The importance of standardizing the procedures of sample and slide preparation for computer-assisted morphologic analysis has been emphasized in human and veterinary andrology. The purpose of this study was to optimize slide preparation (dilution grade and sperm washing), staining procedures and analysis conditions (colour of light source and objective magnification) for the morphometric analysis of bull spermatozoa using the Hamilton Thorne morphology analyzer integrated visual optical system (IVOS). For experiment 1, one ejaculate was collected from one bull and diluted to 200 000,300 000 spermatozoa/,l. Slides were prepared and stained using seven different procedures: rapid Papanicolaou (PAP), rapid Papanicolaou with prolonged staining times (PAP+), Diff-Quik (DIF), haematoxylin (HEM), Farelly (FAR), Spermac (SPER) and the modified GZIN (MGZIN) staining. All slides were analysed using a Hamilton Thorne Morphology Analyser IVOS equipped alternatively with a red, green or blue light source, and a 40× or 100× oil immersion objective. Recognition and digitization errors as well as morphometric parameters were determined. The IVOS was unable to detect DIF-stained spermatozoa. The GZIN and the SPER staining as well as the blue light source led to unsatisfactory results. Among the staining methods examined, the FAR, HEM, PAP+, and PAP staining, preferably in combination with the green light source, and the 40× objective yielded optimal results concerning sperm recognition and digitization. The 100× objective did not allow reliable analysis of the sperm heads because of a frequently appearing digitization error. For experiment 2, three ejaculates were collected from each of three bulls and diluted to five dilution grades (100 000,500 000 spermatozoa/,l). An aliquot of each dilution grade was washed additionally. The percentage of correctly digitized sperm heads decreased with increasing spermatozoal concentration. However, the evaluation speed increased. The range of 200 000,300 000 spermatozoa/,l appeared to be a reasonable compromise for both criteria. Sperm washing failed to further improve the analysis results. Sperm head dimensions were influenced significantly by all variations of the methods in both experiments. In conclusion, using the proposed methods, the IVOS allows precise and reliable morphometric analyses of bull spermatozoa. The consistent application of these procedures may lead to an inter-laboratory standardization and to further establishment of generally accepted morphometric criteria used in human andrology (e.g. World Health Organisation or strict criteria). [source] A review of vaccines for HIV preventionTHE JOURNAL OF GENE MEDICINE, Issue 1 2003Matilu Mwau Abstract HIV/AIDS has become the most devastating pandemic in recorded history. It has killed 40 million people in the last 20 years and the World Health Organisation estimated that at least 14 000 new infections occurred daily in 2001. There will be up to 100 million new infections in the next 10 years (for current updates, visit http://www.unaids.org/epidemic_update/). Most HIV infections occur in the developing world, and the adverse social and economic impact of the HIV/AIDS pandemic, particularly in the developing world, is unprecedented. Highly active antiretroviral therapy (HAART) has had significant effects on HIV/AIDS in the developed world. The drugs have acted to prolong survival, reduce the viral load, and to alleviate suffering. However, the incidence of side effects and resistance is high and the drugs are unaffordable and unavailable in the developing world. HAART regimens are difficult to comply with. Public health efforts to modify the behaviour, attitude and culture that accelerate the spread of HIV/AIDS have had only modest success. There is urgent need for a prophylactic and/or therapeutic HIV vaccine. This is a review of the obstacles and current trends in HIV vaccine development. Copyright © 2002 John Wiley & Sons, Ltd. [source] The history of tocolysisBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2003Marc J.N.C. Keirse In 1950, the World Health Organisation (WHO) defined prematurity as a birthweight of 2500 g or less and in 1961 as a gestational age of less than 37 weeks. The time in between marks an era in which there was growing recognition of the importance of gestational age at birth and how to influence it. The latter was facilitated too by the development of tocography, which permitted some semi-objective measurement of uterine contractility. Along with it, came a growing interest in agents that could control uterine contractility beyond the earlier classical approaches of hormones and gastrointestinal spasmolytics. Hence, the early 1960s saw much research interest in agents, such as nylidrine, isoxsuprine, and orciprenaline that could suppress uterine contractility as one of their many beta-agonist properties. Subsequently, two approaches would be used to shift the balance towards uterine function over and above the influence on other bodily functions. One consisted of supplementing these drugs with agents, such as calcium antagonists and beta-receptor blockers that were hoped to suppress non-uterine actions. The other was a search for drugs in the same class with greater uterospecificity and more selective binding to uterine as opposed to other receptors. Neither of these approaches has ever fully fulfilled the hopes that were pinned on them, but they resulted in the availability of a large number of agents to suppress uterine contractility. The advent of prostaglandins as regulators of uterine contractility and the ability to suppress their biosynthesis saw another range of attempts to suppress uterine activity. They included aspirin, sodium salicylate, flufenamic acid, sulindac and indomethacin, but some were clearly based on a defective understanding of how uterine prostaglandin synthesis can be influenced. In the meantime, a flurry of other agents came and went, often more than once, testifying to the ingenuity of clinicians in trying to solve a problem that is poorly understood. Some, such as relaxin and ethanol, came and disappeared. Others, such as calcium antagonists, entered the scene as protectors against the non-uterine effects of other agents, went, and re-entered the scene in their own right. Still others, such as magnesium sulphate, came, lingered around, and became credited with effects in preterm labour that do not depend on affecting uterine contractility. Amidst this all arose the term tocolysis, coined in 1964 by Mosler from the Greek stems ,,,,' and ,,,,,,', to epitomise all of this ingenuity. [source] The impact of managed care on nurses' workplace learning and teaching,NURSING INQUIRY, Issue 2 2000Jerry P. White The impact of managed care on nurses' workplace learning and teaching This paper examines the impact of managed care on the informal learning process for nurses in a major US-based health organisation. Through the analysis of focus group data we report the nurses' view of the effect recent changes have had on the nurse/patient/care relationship. Managed care, our research indicates, has transformed the learning milieus for nurses with two effects. First, nurses have seen their need for informal learning increase while the time and context for that learning has diminished. Second, the process of teaching patients and families has also been adversely affected even as managed care creates the need for more patient education. We report the analysis of the data collected at group interviews involving nurses working in both hospital and community settings of a leading US-based HMO. All interviews took place during September of 1997 at various sites in California. This study is part of a larger Social Science Research Council of Canada funded investigation into managed care in the US and Canada. [source] University faculty perceptions of the health risks related to cigarettes and smokeless tobaccoDRUG AND ALCOHOL REVIEW, Issue 2 2010NICHOLAS PEIPER Abstract Introduction and Aims. It is now widely understood by tobacco research and policy experts that smokeless tobacco (ST) use confers significantly less risk than smoking, but no studies have assessed tobacco risk perceptions in highly educated populations. The purpose of this study was to explore the perception of risks related to smoking and ST use among full-time faculty on two campuses at the University of Louisville. Design and Methods. In October 2007, a survey that quantified risk perceptions of cigarette smoking and ST use with respect to four health domains (general health, heart attack/stroke, all cancer, oral cancer) was sent to 1610 full-time faculty at the Belknap and the Health Sciences Center (HSC) campuses of the University of Louisville, and 597 (37%) returned a completed survey. Results. Overall, cigarettes were considered as high risk for all health domains by large majorities (75,97%). Except for heart attack/stroke, ST was also considered as high risk by the majority of faculty (69,87%), and at least half perceived cigarettes and ST to be equally harmful across all domains. HSC faculty had somewhat more accurate risk perceptions than Belknap faculty for ST, but both groups overestimated the risks, especially for oral cancer. Discussion and Conclusions. This study found that the risks of ST use are overestimated and conflated to that of cigarettes among highly educated professionals, demonstrating the need for better education about the risks of tobacco use and for communication of accurate information by health organisations and agencies.[Peiper N, Stone R, Van Zyl R & Rodu B. University faculty perceptions of the health risks related to cigarettes and smokeless tobacco. Drug Alcohol Rev 2010] [source] Using Soft Systems Methodology for Performance Improvement and Organisational Change in the English National Health ServiceJOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT, Issue 4 2004Brian Jacobs The Soft Systems Methodology (SSM) advocated by Checkland and Scholes (1990) has considerable potential. It can provide policy makers, professionals, and managers in complex health organisations with a valuable addition to management approaches leading to practical improvements through innovative organisational change. With reference to the English National Health Service (NHS), this author argues that SSM can enable managers and others to address problem situations holistically, identify critical issues, and reach an accommodation of different viewpoints as a basis for improvement. The SSM approach can usefully compliment strategic frameworks, such as the Balanced Scorecard, in achieving clarity of thinking about performance and change issues'. [source] Profile of the Australian dietetic workforce: 1991,2005NUTRITION & DIETETICS, Issue 3 2006Leanne BROWN Abstract Objective:, The present study aims to review current available data that describe the dietetics workforce in Australia. Design:, A literature search was conducted using CIHNAL and hand searches. Following this, a review of the current available dietetics workforce data was conducted. Dietitians Association of Australia (DAA) membership data were analysed. Subjects and setting:, Sources of workforce data included: the Australian Bureau of Statistics Census data, DAA membership database, state health department and national workforce reports, reports by allied health organisations and independent research. Main outcome measures:, Descriptive data profiling the Australian dietetic workforce and employment trends. Statistical analysis:, A descriptive analysis of DAA membership data was undertaken. The DAA membership data were mapped by postcode with the Australian Standard Geographical Classification for remoteness. Counts and proportions were used to summarise and compare available data. Results:, There has been a growth and diversity of the dietetics profession in Australia in recent years, despite a lower proportion of qualified dietitians working as dietitians. The dietetic workforce is relatively young, predominantly female and unevenly distributed across the country. The available data are complex and difficult to interpret. Conclusions:, The present review of currently available dietetic workforce data provides a profile of the dietetics profession in Australia. Further workforce data are required in order to adequately describe the dietetics workforce in Australia and to determine future needs for the profession. National monitoring and systematic workforce data collection are urgently required. [source] A shift to ambulatory medical education in IsraelTHE CLINICAL TEACHER, Issue 2 2010Khaled Karkabi Summary Background:, The Council for Higher Education in Israel published an extensive report in 2007, calling for a significant increase of undergraduate medical education in Israel in ambulatory care settings. The objective of this article is to propose an action plan aimed at shifting undergraduate medical education in Israel towards ambulatory education. Context:, The main barriers to increasing ambulatory education in Israel are lack of academic recognition for teaching and excellence, conflict between patient care, income and teaching, lack of an adequate educational infrastructure and faculty in ambulatory care, and insufficient support and involvement of the health organisations. However, there is great potential for developing ambulatory education in Israel based on existing resources: Israel has a well-established primary care network, has chronic disease management programmes, community-based preventive medicine and health promotion activities, and an emerging structure for home, palliative and terminal care in the community. Innovation:, The proposed action plan presents a framework for enhancing ambulatory education in undergraduate medical education in Israel, and allows site-specific adjustments according to the preferences, resources and capabilities of each of the four medical schools. Implications:, A national shift to ambulatory education in Israel can be implemented through the existing coordination mechanism of the four medical schools. A government funding policy that encourages the collaboration between four medical schools will be beneficial both in terms of resource utilisation and the engagement of other stakeholders. The recognition of community services and educational excellence can be advanced by establishing academies of teaching scholars. [source] Engaging with Aboriginal communities in an urban context: some practical suggestions for public health researchersAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2009Priscilla Pyett Objective: In this paper, one Indigenous and two non-Indigenous public health researchers reflect on our combined experience of over thirty years in Aboriginal health, in order to develop some practical guidelines, particularly for researchers working with urban Indigenous population groups. Approach: Public health research is important not only to address the health inequities experienced by Australia's Indigenous populations, but also to build knowledge and confidence and to inform practice in Aboriginal community-controlled health organisations. Ethical guidelines and previous research experience demonstrate that researchers need to engage with the communities that may be involved in or affected by the research they propose. Although more than half of Australia's Aboriginal and Torres Strait Islander population live in urban and regional centres, most research and commentaries address the health and social issues of remote communities. Researchers often do not know how to engage with urban Aboriginal communities and how to approach the particular research challenges within this context. Conclusion and Implications: The practical guidelines suggested in this paper may assist public health researchers to conduct ethical health research that is planned and carried out in a culturally appropriate way and that will benefit urban Aboriginal people. While not intended to be prescriptive, we believe that the lessons learned in Victoria will be applicable to other urban Indigenous contexts around Australia. [source] | ||||||||||